scholarly journals Critical adjustments in a department of orthopedics through the COVID-19 pandemic

2020 ◽  
Author(s):  
Gonzalo Luengo-Alonso ◽  
Fernando García-Seisdedos Pérez-Tabernero ◽  
Miguel Tovar Bazaga ◽  
José M Arguello-Cuenca ◽  
Emilio Calvo
Keyword(s):  
Surgical Procedures ◽  
Tertiary Hospital ◽  
Cross Sectional Study ◽  
General View ◽  
Trauma Patients ◽  
New Paradigm ◽  
Cross Sectional ◽  
Extreme Stress ◽  
Elective Surgical Procedures ◽  
Set Up

Abstract Purpose:SARS-CoV-2 new scenario has forced health systems to work under extreme stress urging to perform a complete reorganization of the way our means and activities were organized. Orthopedic and trauma have rescheduled their activities to help SARS-CoV-2 units, but trauma patients require also treatment, and no standardized protocols have been established.Methods: Single-center cross-sectional study was performed in a tertiary hospital. Two different periods of time were analyzed: a two-week period time in March 2019 (pre-SARS-CoV-2) and the same period of March 2020 (SARS-CoV-2 pandemic time). Outpatient’s data, emergency activity, surgical procedures and admissions were evaluated. Surgeons and patient´s opinion was also evaluated using a survey.Results:A total of ~16k (15.953) patients were evaluated. Scheduled clinical appointments decreased by ~22%. Urgent consultations and discharge from clinics also descended (~37% and ~20% respectively). Telemedicine was used in 90% of outpatient clinical evaluations. No elective surgical procedures during SARS-CoV-2 time were scheduled, and subtracting the effect of elective surgeries, a reduction of inpatient surgeries, from ~85% to ~59%. Patients delayed trauma assistance more than 48 hours in 13 cases (35%). Preoperative admission for hip fractures decreased in 10 hours on average. Finally surveys stated that patients were more in favor than surgeons to this new way to evaluate orthopedic and trauma patients based strongly on telemedicine.ConclusionDetailed protocols should be standardized for surgical departments during the pandemic. This paper offers a general view in how this virus affects an orthopedic unit and could serve as a protocol and example for orthopedic and trauma units. Even in the worst scenario, an orthopedic and Trauma unit could offer an effective, efficient and quality service. SARS-CoV-2 will set up a new paradigm for health care in orthopedics and trauma.

scholarly journals Prevalence and Predictors of Cancellation of Elective Surgical Procedures at a Tertiary Hospital in Uganda: A Cross-Sectional Study

2020 ◽  
Vol 2020 ◽  
pp. 1-7 ◽  
Author(s):  
Alfred Ogwal ◽  
Felix Oyania ◽  
Emmanuel Nkonge ◽  
Timothy Makumbi ◽  
Moses Galukande
Keyword(s):  
Surgical Procedures ◽  
Orthopedic Surgery ◽  
Elective Surgery ◽  
Cross Sectional Study ◽  
Mulago Hospital ◽  
Sectional Study ◽  
Related Factors ◽  
Cross Sectional ◽  
Elective Surgical Procedures ◽  
Cancellation Rate

Introduction. The cancellation of elective procedures has been shown to waste resources and to have the potential to increase morbidity and mortality among patients. This study aimed to determine the prevalence of the cancellation of elective surgical procedures and to identify the factors associated with these cancellations at Mulago Hospital, a large public hospital in Kampala, Uganda. Methods. A cross-sectional study was conducted from January 10, 2018, to February 20, 2018. We recruited patients of all ages who were admitted to surgical wards and scheduled for elective surgery. Data on patients’ demographic characteristics and diagnosis, as well as the specialty of the surgery, the planned procedure, the specific operating theatre, cancellation, and the reasons for cancellation were extracted and analyzed using logistic regression. Results. Of a total of 400 cases, 115 procedures were canceled—a cancellation prevalence of 28.8%. Orthopedic surgery had the highest cancellation rate, at 40.9% (n = 47). Facility-related factors were responsible for 67.8% of all cancellations. The most common reason for cancellation was insufficient time in the theatre to complete the procedure on the scheduled day. No procedures were canceled because of a lack of intensive care unit beds. There was a significant association between surgical specialty and cancellation (P<0.05) at multivariate analysis. Conclusion. The prevalence of cancellation of elective surgical procedures at Mulago Hospital was 28.8%, with orthopedic surgery having the highest cancellation rate. Two-thirds of the factors causing cancellations were facility-related, and more than 50% of all cancellations were potentially preventable. Quality-improvement strategies are necessary in the specialties that are susceptible to procedure cancellation because of facility factors.

scholarly journals Determining Model for Maximum Blood Request (MSBOS) for Surgery: An Elective Surgery in Imam Ali Hospital, Zahedan, Iran

2019 ◽  
Author(s):  
Seyed Mehdi Hashemi ◽  
Seyed Hossein Soleimanzadeh Mousavi ◽  
Zeinab Tavakolikia
Keyword(s):  
Surgical Procedures ◽  
Blood Donation ◽  
Elective Surgery ◽  
Cross Sectional Study ◽  
Blood Transfusions ◽  
Hernia Surgery ◽  
Cross Sectional ◽  
Elective Surgical Procedures ◽  
The Mean ◽  
Common Problems

Background: Nowadays, excessive blood intake is one of the most common problems in educational hospitals, causing issues such as the lack of proper distribution of blood products among centres, increases in costs and blood bank workloads. So, programs such as a Maximum Surgical Blood Ordering Schedule (MSBOS) were introduced to design a blood ordering schedule, which is a guide to normal transfusion needs for common surgical procedures.  Materials and Methods: This study was a descriptive cross-sectional study. The sampling method was designed and distributed among all sectors of the hospital. Each sector according to the demand for blood and cross-matched transfused units entered the rate of wasted and unused blood bags on the related forms. This study was performed on 1568 patients, of whom 562 (35/84%) were given blood transfusions. Results: The aim of this study was to determine the pattern for the maximum surgical blood order schedule (MSBOS) for elective surgical procedures/in elective surgery cases in Imam Ali Hospital, Zahedan. This study was performed on 1568 patients, of whom 562 (35/84%) were given blood transfusions. The mean C/T ratio was 1.61 ± 0.99, the mean TI was 0.61 ± 0.38, and the mean T index was 36.4 ± 30.16%. Conclusion: In general, only 55% of the blood units were used. Hernia surgery, thyroidectomy, and patients with renal problems had the greatest number of wasted units. Therefore, according to the results, indications of blood donation should be made correctly by health care personnel in all patients requiring a blood transfusion, and if there is an increased number of indications, packed cells are requested.  

scholarly journals Magnitude and causes of cancelation for elective surgical procedures in Debre Tabor General hospital: A cross-sectional study

2021 ◽  
Vol 9 ◽  
pp. 205031212110033
Author(s):  
Basazinew Chekol Demilew ◽  
Hiwot Yisak ◽  
Agazhe Aemiro Terefe
Keyword(s):  
General Hospital ◽  
Surgical Procedures ◽  
Elective Surgery ◽  
Cross Sectional Study ◽  
Study Data ◽  
Cross Sectional ◽  
Elective Surgical Procedures ◽  
Organizational Issues ◽  
Debre Tabor ◽  
Prospective Study Design

Objectives: Elective surgical case cancelation is a common problem and can cause prolonged wait times, harm to patients, and is a waste of scarce resources. Reasons for cancelations are complex and change place to place because they are related to patients, organizational issues, and clinical staff. So, this study is aimed to assess the magnitude and causes of the case cancelation among elective surgical cases in a general hospital. Methods: A cross-sectional prospective study design was conducted on 221 patients scheduled for elective surgery from March 1 to May 30 2019 G.C. All consecutive elective surgical cases scheduled during the study period were included in the study. Data were collected using prepared and pretested questionnaire and entered in the SPSS version 20 for analysis purpose. Results: During the study, 221 patients were scheduled for elective surgical operations, among these 150 (67.9%) patients were operated on the planned date of surgery whereas 71 (32.1%) operations were canceled. The decision for the cancelation was done by the anesthetist due to preoperative coexisting disease findings and inadequate preparation of the patient for the intended operations were 33 (46.5%) followed by administrative-related issues which account 26 (36.6%). Conclusion: Cancelation of elective surgical procedures on the day of surgery was high in this study due to different reasons. Cancelation can be minimized if all the responsible bodies can communicate early regard to the patient.

scholarly journals Prevalence and factors associated with cancellation of elective procedures on surgical wards at Mulago hospital, Uganda

2019 ◽  
Author(s):  
alfred ogwal ◽  
felix oyania ◽  
emmanuel nkonge ◽  
timothy kabanda makumbi ◽  
fred moses galukande
Keyword(s):  
Surgical Procedures ◽  
Elective Surgery ◽  
Demographic Data ◽  
Cross Sectional Study ◽  
Mulago Hospital ◽  
Sectional Study ◽  
Cross Sectional ◽  
Factors Associated ◽  
Elective Surgical Procedures ◽  
Cancellation Rate

Abstract Background: Cancellation of elective surgical procedures has been noted to waste resources and with potential to increase morbidity and mortality among patients. This study set out to determine the prevalence and factors associated with cancellation of elective surgical procedures at Mulago Hospital. Methods: A prospective cross-sectional study was conducted from 10 th January 2018 to 20 th February 2018. We recruited patients of all ages admitted on surgical wards and scheduled for elective surgery. Demographic data, diagnosis, specialty of surgery, proposed surgery, theatre and reasons for cancellation were extracted and analyzed using logistic regression. Results: There were 115 procedures canceled out of 400 cases, giving us a prevalence of cancellation of 28.8%. Neurosurgery had the highest cancellation rate at 46.8% (n=29), OR = 2.23, 95% CI (1.22, 4.06). UCI theatre was about two times more likely to have a procedure canceled (OR = 2.12, 95% CI, 0.91-4.96). Facility factors contributed 67.8% to overall cancellations. Commonest reason for case cancellations was theatre time run out. There was no procedure canceled due to lack of ICU bed. There was a significant association between specialty and surgical cancellation rate (p < 0.05). Conclusions: The prevalence of cancellation of elective surgical procedures in Mulago Hospital is 28.8% with Neurosurgery having the highest cancellation rate. Two thirds of the factors responsible for procedure cancellations were facility related with more than fifty percent of them being potentially preventable. Quality improvement strategies are necessary in those sub specialties susceptible to procedure cancellations due to facility factors. Keywords: cancellation; elective procedures; factors; prevalence

scholarly journals Comparison of Shiraz Trauma Transfusion Score (STTS) Potency With Common Scoring Systems for Trauma in Predicting the Short and Long Term Mortality of Injured Patients

2021 ◽  
Author(s):  
Sepideh Vosooghi Rahbari ◽  
Hamidreza Hosseinpour ◽  
Mohamadreza Karoobi ◽  
Hojat Abolghasemi ◽  
Ali Shahabinezhad ◽  
...  
Keyword(s):  
Scoring Systems ◽  
Cross Sectional Study ◽  
Study Data ◽  
Mortality Prediction ◽  
Trauma Patients ◽  
Cross Sectional ◽  
Predictors Of Mortality ◽  
Trauma Scoring ◽  
Set Up ◽  
Mechanism Of Trauma

Abstract Background and Objective: Trauma is the leading cause of death in people under 40 years of age worldwide. Various studies have been conducted focused on reducing the annual mortality rate due to trauma. One of the most important measures is reducing the time between the incident and the treatment set up, therefore the estimation of the severity of trauma and progressing to mortality before further evaluation is justified. In this study, we aim to compare different trauma scoring systems (such as GAP, MGAP, RTS, TRISS) with a relatively new model – Shiraz Trauma Transfusion Score (STTS) – and to describe the best qualities of these scoring systems for trauma patients in short (less than 24 hours) and long (more than 24 hours) term.Methods: In this cross-sectional study, data from hospitalized trauma patients in Rajaei hospital (center B) of Shiraz, Iran from May to November 2016 were collected and analyzed. Collected data consisted of age, sex, hospital admission duration, mechanism of trauma along with clinical data for calculating different trauma scoring systems, were recorded. Results: while RTS and STTS were the best predictors of mortality in trauma patients in the first 24 hours (sensitivity of 100.00%), GAP and MGAP were the best predictors of the patients’ survival (specificity of 93.83% and 92.59%). GAP and ISS were the best predictors of mortality in trauma patients for more than 24 hours (sensitivity of 82.02%). On the other hand, TRIS and RTS were the best predictors of patients' survival (specificity of 82.59% and 80.26%).Conclusions: Our study findings suggest that the utility and applicability of Shiraz Trauma Transfusion Score(STTS) in predicting mortality is not only comparable with other commonly used scoring methods but it may be of more value in shortterm mortality prediction.

scholarly journals Preoperative fasting time in children undergoing elective surgical procedures

Rev Rene ◽  
2021 ◽  
Vol 22 ◽  
pp. e61347
Author(s):  
Larissa Silva Bergantini ◽  
Sueli Mutsumi Tsukuda Ichisato ◽  
Mariana Salvadego Águila Nunes ◽  
Carlos Alexandre Molena Fernandes
Keyword(s):  
Surgical Procedures ◽  
Medical Records ◽  
Age Groups ◽  
Cross Sectional Study ◽  
Preoperative Fasting ◽  
Surgical Specialty ◽  
Cross Sectional ◽  
Elective Surgical Procedures ◽  
Significant Difference ◽  
Fasting Time

Objective: to verify the preoperative fasting time in children undergoing elective surgical procedures. Methods: cross-sectional study, carried out with information obtained from 20 children’s medical records, submitted to descriptive and inferential statistical analysis. Results: the median fasting time was 8.03 hours. The shortest time recorded was 7 hours and 45 minutes and the longest 17 hours and 30 minutes. School children had the longest pre-anesthetic fasting time. In 16 cases, fasting after midnight was prescribed. There was no statistically significant difference between fasting time and the variables age groups and surgical specialties. No correlation was found between the child’s age and fasting time. Conclusion: the median fasting time was shorter than that found in other studies. The patients fasted for longer intervals than recommended. Fasting time was not related to age group, surgical specialty, and age of the child.

scholarly journals Comparison of Shiraz Trauma Transfusion Score (STTS) Potency With Common Scoring Systems for Trauma in Predicting the Short and Long Term Mortality of Injured Patients

2021 ◽  
Author(s):  
Sepideh Vosooghi Rahbari ◽  
Hamidreza Hosseinpour ◽  
Mohamadreza Karoobi ◽  
Hojat Abolghasemi ◽  
Ali Shahabinezhad ◽  
...  
Keyword(s):  
Scoring Systems ◽  
Cross Sectional Study ◽  
Study Data ◽  
Mortality Prediction ◽  
Trauma Patients ◽  
Cross Sectional ◽  
Predictors Of Mortality ◽  
Trauma Scoring ◽  
Set Up ◽  
Mechanism Of Trauma

Abstract Background and Objective: Trauma is the leading cause of death in people under 40 years of age worldwide. Various studies have been conducted focused on reducing the annual mortality rate due to trauma. One of the most important measures is reducing the time between the incident and the treatment set up, therefore the estimation of the severity of trauma and progressing to mortality before further evaluation is justified. In this study, we aim to compare different trauma scoring systems (such as GAP, MGAP, RTS, TRISS) with a relatively new model – Shiraz Trauma Transfusion Score (STTS) – and to describe the best qualities of these scoring systems for trauma patients in short (less than 24 hours) and long (more than 24 hours) term.Methods: In this cross-sectional study, data from hospitalized trauma patients in Rajaei hospital (center B) of Shiraz, Iran from May to November 2016 were collected and analyzed. Collected data consisted of age, sex, hospital admission duration, mechanism of trauma along with clinical data for calculating different trauma scoring systems, were recorded. Results: while RTS and STTS were the best predictors of mortality in trauma patients in the first 24 hours (sensitivity of 100.00%), GAP and MGAP were the best predictors of the patients’ survival (specificity of 93.83% and 92.59%). GAP and ISS were the best predictors of mortality in trauma patients for more than 24 hours (sensitivity of 82.02%). On the other hand, TRIS and RTS were the best predictors of patients' survival (specificity of 82.59% and 80.26%).Conclusions: Our study findings suggest that the utility and applicability of Shiraz Trauma Transfusion Score(STTS) in predicting mortality is not only comparable with other commonly used scoring methods but it may be of more value in shortterm mortality prediction.

Conflict Avoidance in Old Age

GeroPsych ◽  
2017 ◽  
Vol 30 (2) ◽  
pp. 61-70 ◽  
Author(s):  
Lia Oberhauser ◽  
Andreas B. Neubauer ◽  
Eva-Marie Kessler
Keyword(s):  
Social Support ◽  
Perceived Social Support ◽  
Well Being ◽  
Cross Sectional Study ◽  
Conflict Avoidance ◽  
Subjective Well Being ◽  
Sectional Study ◽  
Cross Sectional ◽  
Adult Lifespan ◽  
Set Up

Abstract. Conflict avoidance increases across the adult lifespan. This cross-sectional study looks at conflict avoidance as part of a mechanism to regulate belongingness needs ( Sheldon, 2011 ). We assumed that older adults perceive more threats to their belongingness when they contemplate their future, and that they preventively react with avoidance coping. We set up a model predicting conflict avoidance that included perceptions of future nonbelonging, termed anticipated loneliness, and other predictors including sociodemographics, indicators of subjective well-being and perceived social support (N = 331, aged 40–87). Anticipated loneliness predicted conflict avoidance above all other predictors and partially mediated the age-association of conflict avoidance. Results suggest that belongingness regulation accounts may deepen our understanding of conflict avoidance in the second half of life.

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